Month: July 2017

BOSTON & STORRS, Conn.–(BUSINESS WIRE)–WHOOP, the human performance company, and the Korey Stringer Institute (KSI) at the University of Connecticut (UCONN) today announced the completion of a landmark performance study involving Division I Collegiate athletes. The study, which was conducted with 40 UCONN athletes (26 males and 14 females) from March 2016—December 2016, was designed to explore areas of human athletic performance and recovery, and how sleep, heart rate (HR) and heart rate variability (HRV) metrics can be integrated together and inform decision making to promote optimal performance, speed recovery, and promote general health and wellness. It is the most comprehensive study of its kind to date—collecting close to one terabyte of physiological data over the course of 8 months—and the initial findings were presented earlier this month at the 40th Annual NSCA Conference in Las Vegas, NV.

“The magnitude and quality of the data collected, including sleep and recovery metrics from WHOOP, has made this the most comprehensive study of athlete performance conducted to-date.”

“It has always been critical for us to ground WHOOP’s technology in science and push the boundaries to unlock human performance. This collaboration between KSI and WHOOP will help us better educate and guide best-practices for maximizing performance and recovery,” said John Capodilupo, WHOOP Co-Founder and CTO. “The magnitude and quality of the data collected, including sleep and recovery metrics from WHOOP, has made this the most comprehensive study of athlete performance conducted to-date.”

The study examined the recovery metrics of the UCONN men’s soccer and women’s cross country teams participating in the 2016-2017 season. Data collection was conducted during off-season training phases and over the course of their full athletic season. Along with collecting sleep and recovery assessments using the WHOOP strap, other variables measured included athlete demographics, training and competition loads, fitness and hydration status, wellness and blood-biomarkers.

“As scientists and practitioners, we are continually trying to connect critical pieces of the performance puzzle and ‘bridge the gap’ between science and practice. However, the critical piece missing is often the time athletes spend outside of training,” said Ryan Curtis, Associate Director of Athlete Performance and Safety, Korey Stringer Institute. “The collaboration with WHOOP allowed us for the first time to gather objective data on how our athletes were recovering outside of training. This is allowing us to define relationships not previously shown and in turn, give actionable insights to coaches, practitioners and researchers.”

The first analysis of the data focused on the relationship between sleep, training load and fitness and revealed positive correlations between:

Training load metrics such as total and average distance, high speed distance, high-intensity accelerations and deceleration and light sleep time

Athlete body fat percentage and average sleep disturbances

Athletes average slow wave sleep time (important for recovery and anabolic hormone release) and high-intensity running.

The ongoing analysis of the study will also explore relationships between WHOOP Recovery and associated metrics with other physiological data collected throughout the study.

“The Korey Stringer Institute at the University of Connecticut is passionately committed to maximizing the performance and health of athletes, warfighters and laborers,” said Douglas Casa, Chief Executive Officer of UCONN’s Korey Stringer Institute. “Our work with WHOOP has enhanced our ability to achieve our goals as an organization since they are committed to the same ideals and have a product that can assist with understanding important components of recovery an athlete is currently experiencing. Our data indicates that WHOOP has the potential to be an important tool in the decision-making process regarding training planning.”

About WHOOP
WHOOP, a company committed to unlocking human performance, is transforming how athletes understand their bodies and inner potential. Designed for the 24-hour performance lifestyle, the award-winning WHOOP Strap 2.0 is worn by the most elite athletes in the world to positively change behavior, provide actionable recommendations and avoid overtraining. WHOOP provides individuals, teams, and their coaches and trainers with a continuous and personalized understanding of Strain, Recovery, and Sleep to balance training, reduce injuries, and predict performance. Join the best athletes in the world and learn more by visiting www.WHOOP.com.

About the Korey Stringer Institute
The Korey Stringer Institute (KSI) is housed in the Department of Kinesiology within the College of Agriculture, Health and Natural Resources at the University of Connecticut (UConn). UConn’s Department of Kinesiology has a strong tradition and reputation as one of the leading institutions studying health and safety issues for athletes and the physically active. The mission of KSI is to provide research, education, advocacy and consultation to maximize performance, optimize safety and prevent sudden death for the athlete, soldier and laborer. For more information, visit: www.ksi.uconn.edu.

Heat? Humidity? Be smart and you can still work toward your goals.

Beers, burgers, and county-fair funnel cake aren’t the only things that might weigh you down this summer: sweltering weather can make even a short run feel like a trudge through six inches of mud. As the sun beats down, your core temperature shoots up, sending blood away from muscles to the surface of skin to help heat dissipate.

It’s uncomfortable, but science says training in the heat is worth the trouble: Hot-weather workouts teach your body to sweat more (which keeps you cool), increase your blood-plasma volume (which benefits cardiovascular fitness), and lower your core body temp—all adaptations that help you perform better in any weather. But how hot is too hot? “I tell people to use caution when it’s more than 80 degrees out, or 90 degrees if you’re heat-acclimatized, and if the humidity is high, you need to make even more adjustments,” says Douglas Casa, Ph.D., head of the University of Connecticut’s Korey Stringer Institute, which studies enhancing performance in the heat. Follow these specific tweaks depending on what you’re training for.Try RW Art Director Erin Benner’s workout for steamy days: Grab a noodle, jog 10 to 15 minutes to your local pool, then remove your shoes and jump in. Spend 15 to 20 minutes aqua-jogging with the noodle looped under your ’pits, then put your shoes on and jog home. Apply antichafing balm prerun to avoid postpool discomfort.

If you’ve penciled in a long run and starting at 4 or 5 a.m. isn’t an option, make sure you’ve had a solid night’s rest, which enhances heat tolerance, says Casa. Avoid out-and-back routes (which don’t give you the option to bail), and tweak your expectations: “Many of us are around 10 percent slower in the heat,” says Casa. Try running for time instead of distance on super-hot days: If an 18-miler normally takes you three hours (10:00 pace), run for three hours at the same effort level.

Prep for postwork races by packing hydrating fruit and veggie snacks (like carrots, cucumbers, strawberries, and cantaloupe) to nosh on throughout the day. And chill a bandanna to wrap around your neck during the run: A recent study found that such cooling tactics during a race are more effective than precooling strategies when it comes to boosting performance in the heat. You’ll also want to halve your standard warmup to avoid overheating, says Ben Rosario, head coach of Hoka One One Northern Arizona Elite. So if you typically jog for 10 minutes and do dynamic stretches for 10 minutes prerace, do each for five instead—your muscles warm up more quickly in hot conditions. Set goals depending on how the elements look that day. One idea is to focus on place instead of time: If you know you’re among the top 50 in a given race on a cooler day, shoot for the same approximate place when it’s hot.

Stay flexible as you cross off your two or three swimming, biking, and running workouts per week: “We ensure we’re swimming in the heat of the day and running and biking when it’s cooler, and we’ll pick bike routes that pass gas stations for ice to put in jerseys and sports bras,” says Jeff Bowman, owner and coach at Rev Tri Coaching in Tallahassee, Florida. During warm workouts, experiment with hydration to find the right balance of fluids and electrolytes for your needs, and practice drinking on the bike and on the run. When there’s a heat advisory, Bowman’s athletes move running and biking workouts indoors, where they can put in an intense effort with workouts such as the compound brick: “It’s pretty common for us to have to train inside—we’ll do run/bike/run/bike/run/bike (or vice versa) and increase the intensity each subsequent run/bike block,” he says. “But we make sure there’s air conditioning, fans directed at your face and body, and cool fluids.”

If the weather’s taking the life out of your workout, change plans: Join a spin class, pop in a workout DVD, or go for an aqua-jog. As long as you’re clocking at least three moderate to tough runs weekly (inside or outside), for at least half of your usual weekly volume, you’ll maintain base fitness and be able to ease back into your normal schedule as the days become more tolerable. When you’re enduring hot temps, trade heat-radiating roads and sidewalks for dirt or grass; run shaded loops where you can re-up on water and ice; and go by feel instead of pace.

These four tips will help keep you from overheating during summer workouts
By Catherine Roberts
July 23, 2017

With summer in full swing, you’re probably outside more than usual. And chances are it feels hot out there, particularly when you’re exerting yourself.

Most of the time, your body is quite good at regulating its internal temperature. “The body’s main way that it cools itself is through sweat,” says Michelle Cleary, Ph.D., associate dean of graduate programs at Chapman University, in Orange, Calif.

But if you aren’t drinking enough to keep up with the fluid lost in sweat, your body can heat up too much and become dehydrated.

When you’re physically active under these conditions, you can feel lethargic and uncomfortable, but in some cases, you can actually become dangerously sick. A 2011 study found that playing sports, exercising, and doing yard work were among the most common causes of heat-related emergency room visits.

But you don’t have to stay inside this summer to stay safe. These best practices will help keep you from overheating during your summer workouts.

Dress Right and Safeguard Your Skin
What you wear can help keep you cooler when you’re exercising or working outdoors.

“You want to avoid anything that traps moisture against your skin,” Cleary says. Opt for lightweight, loose-fitting items, which allow sweat to evaporate more easily. Also, stick with light colors, which absorb less heat than dark ones. Moisture-wicking polyesters may help move sweat away from your skin, where it can evaporate and cool you down.

Protect yourself from the sun’s rays, too, by wearing sunscreen with an SPF of 40 or higher (check our sunscreen ratings for best brands) during your outdoor summer workouts. Apply it at least 15 minutes before you go outside, and reapply at least every two hours.

Not only does sunburn raise your risk of skin cancer, but, according to Luke Pryor, Ph.D., professor of kinesiology at California State University, Fresno, it can hamper your body’s ability to cool itself by damaging your sweat glands.

Stay Hydrated
Your body is about 60 percent water, which allows your kidneys to filter out waste and your blood to transport nutrients throughout your system. Your sweat mechanism also helps keeps your body at the right temperature, between 97 and 99 degrees Fahrenheit.

How much water do you need? The Institute of Medicine recommends that men consume 3.7 liters of water daily and women 2.7 liters (from food and non-alcoholic beverages).

Instead of trying to keep track of your liters, Sarah Fowkes Godek, Ph.D., director of the HEAT Institute at West Chester University of Pennsylvania, recommends that you rely on your sense of thirst to tell you how much water to drink.

“Our thirst mechanism is adequate and very well developed,” Fowkes Godek says. The exception is older adults. Your sense of thirst diminishes as you age, so relying on thirst for seniors may not be sufficient to keep them hydrated. See our advice for older adults here.

As for what to drink, water is best, says Fowkes Godek. While you do lose important nutrients known as electrolytes —such as sodium, magnesium and potassium—when you sweat, she says most people have no need for sports drinks or other beverages fortified with electrolytes. Most people get enough nutrients from meals and snacks to replace what they lose, and sports drinks often contain a lot of added sugars.

The exceptions: People who work out for more than an hour at a time, and workers who labor for long hours outside in the heat may need to replace electrolytes.

Consuming water-rich foods like melon, citrus, and leafy greens can also help keep you hydrated. And while the heat may blunt your appetite, try to have a small snack of about 150 to 200 calories an hour to 30 minutes ahead of your workout—if you haven’t had a meal within the prior four hours. Refuel within an hour afterward. (See our advice on what foods are best to eat before and after any workout.)

Time Your Activity Right
During the summer, do as much of your outdoor physical activity in the morning or evening, when it’s slightly cooler. When outside, stay in the shade as much as possible.

It’s also important to let your body acclimate to exercising or working in the heat, says Douglas Casa, Ph.D., CEO of the University of Connecticut’s Korey Stringer Institute, which produces research and advice on the prevention of heat-related deaths for athletes and workers.

That means, ideally, slowly working up to a full intensity training session or work day. A 2016 analysis found that taking eight to 14 days to acclimatize to exercising or working in the heat may be most effective for minimizing heat stress to your body. But that’s not always practical. Still, if you have an outdoor activity such as a big hiking trip, long-distance run, or a major yard project planned, try to work up to it over a period of days.

Adults who supervise groups of children, at camps or in sports teams, for instance, should make sure they give youngsters a chance to adapt to the heat as well. See tips from the American Academy of Pediatrics on how to keep youngsters safe in the heat.

Watch Out for the Symptoms of Heat Stroke
If you notice any signs of dehydration or heat-related illness—including dizziness or lightheadedness, headache, fatigue, nausea or vomiting, and muscle cramps—take a break from your activity, find shade or a cool room, and drink water.

And note that while the ability to cope with heat and humidity do vary from person to person, some weather conditions merit precautions for all. So, pay attention to heat watches, advisories, and warnings in your area (available through the National Weather Service). On days with these alerts, take extra care to stay hydrated, and consider modifying your activity level or moving your summer workout indoors for the day.

And be on the lookout for signs of heat stroke, which can be fatal if not addressed quickly. The two most important symptoms are body temperature above 104 degrees and central nervous system problems such as losing consciousness, irritable or irrational behavior, mood changes, and disorientation.

You may not have a thermometer on hand, but if you experience one or more of the behavioral symptoms mentioned above during a summer workout, or notice them in someone else, take action: “Get body temperature down as fast as humanly possible,” says Casa at the University of Connecticut.

Move out of the heat and direct sun, and into a cold bath or shower (or use water from the garden hose or any other water that’s available if you can’t get indoors). Flip on a fan or air conditioning to speed cooling. After taking action to cool the person down, call 911.

Athlete monitoring is becoming standard practice for maximizing player performance,reducing injury risk, and optimizing competition readiness. For high-performance programs, monitoring load-performance and load-injury relationships are essential for providing insight into how athletes are responding to stresses incurred during and outside of training and competition. Ultimately, how an athlete performs is impacted by the accumulation of stress and the efficacy of training. Therefore, it is important to evaluate stress imposed during training and match sessions, as well as, the strain incurred by each athlete. Understanding the difference between stressors (i.e., intense exercise, heat, cold, altitude, etc) and the strain (body’s response to stress) experienced by a biological system (i.e., human body) is essential to monitoring and manipulating parameters important for athlete preparation. Other benefits to monitoring athletes beyond determining training efficacy, such as gathering scientific explanations for changes in performance or injury risk, enhancing coach and practitioner confidence when manipulating training loads, and boosting athlete-coach- practitioner relationships all contribute to the efficacy and buy-in of monitoring practices. There are four main purposes for monitoring athletes; optimizing readiness, ensuring proper prescription of stress and recovery (periodization), reducing injury risk, and monitoring safe and effective return to play programs (Figure 1). While each of these purposes are important, emphasis and priority placed on these purposes will vary based on team’s load monitoring philosophy.

Monitoring Training and Competition Load

When monitoring the dosage of stress imposed during training or competition, practitioners and scientists typically refer to training load. Load is simply the product of duration and intensity of activity. Training load can be further described as either external (work imposed independent of internal strain) or internal (response of the body to external load), as shown in Figure 2. The association between external and internal load can give great insight into the status of the athlete (i.e., fresh vs. fatigued). With advancements in wearable technology, monitoring of athletes’ external load has received a great deal of attention. Specifically, global positioning systems (GPS) capabilities have allowed ease of monitoring parameters such as distance, time, and efforts in multiple velocity zones (0-7.2 km/h-walk, 7.2-14.4 km/h-jog, 14.4-21.6 km/h-run, &gt;21.6 km/h-sprint) used for tracking running performance. GPS-enabled devices use positional differentiation to calculate distance and acceleration.

Beyond quantifying the intensity distribution of session types (i.e., match, training, conditioning, etc.), GPS metrics are often reported as aggregate measures such as high-intensity running distance (distance &gt;14.4 km/h), number of sprints (efforts &gt; 25.2 km/h), and average speed (meters per minute). However, GPS technology is limited in its ability to detect external movement beyond positional change and additionally, has serious limitations with tracking movement indoors. This leaves monitoring of indoor team sports such as basketball and volleyball at a disadvantage. However, modern player tracking technology typically uses integrated inertial sensors such as accelerometers, gyroscopes, and magnetometers to help quantify stress imposed in all three planes. Calculated metrics such as PlayerLoad TM (Catapult) from integrated inertial sensors have a strong relationship with running performance measures such as total distance covered, while additionally estimating general load on the body and therefore stress from actions such as tackling, accelerations, decelerations, changes of direction and collisions. Due to the inertial movement sensors ability to detect magnitude of movement (i.e., g-forces) in 3 planes of motion, a single arbitrary unit of load might give a more accurate display of total stresses incurred during activity.

Both physiological and psychological measures such as heart rate, lactate, muscle oxygen, and rating of perceived exertion (RPE) can be used to monitor loads sustained internally. Of the numerous methods of objectively quantifying internal load, heart rate derivatives such as time in heart rate zones, expressed as percent of maximum heart rate, and weighted scores such as training impulse (TRIMP) are most commonly used. These measures allow categorization of training stress into relative zones such as high, moderate, and low. Of the methods to quantify internal load by subjective means, using RPE and session RPE (sRPE) are by far the most common. sRPE is simply the product of session duration and the athlete-reported RPE post-training/competition. This subjective measure has shown good association with external running performance measures.

Monitoring Readiness, Recovery and Wellness

Monitoring readiness, recovery, and wellness requires both physiological and psychological assessment in order to gain understanding of an athlete’s true state. These assessments could be as simple as asking the athlete “how do you feel?” or as complex as using microtechnology (telemetry or photoplesthsmography) to ascertain the variability in heart beat to beat intervals during rest or sleep. Monitoring the response to training and/or competition gives the practitioner great insight into individual dose-response relationships and helps to promote precision with recovery practices. For example, if an athlete is excessively fatigued, coaches may prescribe a recovery session or reduce training load for that day. Current practices in monitoring athlete readiness prior to activity include heart rate-based autonomic nervous system assessment (i.e., heart rate variability, HRV; heart rate recovery, HRR), neuromuscular function tests (i.e., counter movement jump, CMJ; reaction tests), and wellness questionnaires/assessments (i.e., stress, fatigue, soreness, anxiety). More extensive monitoring such as biochemical/immunological/hormonal assessment (i.e., blood, saliva, and urine-biomarkers) and psychological inventories (i.e., Profile of Mood States, Sport Anxiety Scale, Rest and Recovery Questionnaire) can give insight into overtraining or maladaptation if assessed longitudinally.

Limitations in Athlete Monitoring

While there is much to gain from monitoring athletes, there are several limitations that must be considered when implementing a monitoring program. Monitoring athletes does not always require large funding sources (i.e. subjective markers of training load combined with wellness reporting), however analyzing data does require time, manpower, and experience/skill. With vast amounts of data pouring in from sometimes multiple technologies and questionnaires, persons experienced in data management and analysis are often needed derive meaning and interpretation beyond simple descriptive reporting. In addition, attaining buy-in from athletes and coaching staff is sometimes difficult if immediate returns are not seen. Regarding technological limitations, very little validation and reliability testing is conducted by parties outside of the technology manufacturer. With that, the way in which raw data is processed and filtered varies by manufacturer and software version. Because software updates can occur quite often and the way in which data is filtered and reported is changed, validity and reliability of the device will change concurrently. This has severe implications when determining the precision and consistency of measurement longitudinally.

Taken together, programs must weigh the benefits and limitations of athlete monitoring together. Without structure in data management, plans for implementation based on data analysis, and athlete-coach buy-in, monitoring athletes can be a waste of time and resources that could be used to gain advantage elsewhere. However, if care is taken in promoting, structuring, and implementing a purposeful and practical monitoring program, teams stand to gain a great advantage in maximizing the health and performance of their athletes.

So has anybody ever heard a story about an idea that was born in a bar or restaurant, with the initial concepts drawn on a napkin? I know I was skeptical of such tales. That was until I was part of this exact situation.

Picture three athletic trainers, one of whom had talked to both individuals, but the other two had never met before. We met at the first annual Collaborative Solutions for Safety in Sport conference in New York City in 2015. I saw this as an opportunity to finally bring a guy with previous experience using a program called Zee Maps together with an athletic trainer who is also a researcher and explain that the three of us needed to collaborate on a project to assist with collecting data on the secondary school setting. The venue where this meeting took place was a restaurant called Dos Caminos in New York City.

By the end of the evening, we had the name of the project, the data that we wanted to collect, and the questions that would be asked all jotted down on a napkin. We all found something we were passionate about and were brainstorming how we could best merge all our ideas together. We were so busy and lost in thought and dialogue that we totally lost track of time and found that the restaurant staff had cleaned the entire place and got ready for the next day before we ever knew what was going on around us. This is where the Athletic Training Locations and Services (ATLAS) project was born and started to develop its personality. The players were Ronnie Harper, EdD, ATC, co-owner of My Sports Dietitian and Head Athletic Trainer at Dutchtown High School in Geismar, La., Rob Huggins, PhD, ATC, Vice President of Research and Athlete Performance at the Korey Stringer Institute (KSI), and myself.

As of today, 71 percent of all secondary schools in the country have been mapped on the ATLAS project. Currently, NATA Districts 1, 2, and 3 are tied with 91 percent of the schools mapped in their districts.

Since that time, the ATLAS program has evolved into a living, breathing project that is just starting to realize its potential. While its original goal was to collect data on employment status, hiring practices, the number of athletic trainers at a particular secondary school, and the size of school, it has grown to push student safety initiatives, track emergency action plan (EAP) use, track trends in hiring practices, see how athletic trainers work with their team physicians, track who has AEDs, track the number of student-athletes, track what sports are offered, and more. State leaders, legislators, state and national medical associations, parent groups, and school administrators are now asking for data that helps change the landscape of athletic health care at the secondary school level.

If you haven’t taken the time to get your high school accurately mapped or taken the five-minute survey, then you are in the minority. As of today, 71 percent of all secondary schools in the country have been mapped. Currently, NATA Districts 1, 2, and 3 are tied with 91 percent of the schools mapped in their districts.

While we still have a ways to go, the ATLAS project marks the first time we’ve been able to collect information on all of the approximately 22,000 high schools across the country. Before, data collection was not as robust, and we relied on other school personnel for the information. Now, we are dealing directly with athletic trainers. This in itself has helped to increase involvement and accuracy.

While the ATLAS questionnaire consists of 27 questions total, here is a snapshot of the information requested:

• Name

• Credentials

• School name and address

• Public or private or other type of institution?

• Are you full time or part time?

• How are you employed?

• Do you have venue-specific EAPs?

• Do you have Standard Operating Procedures (SOPs)?

• Who signs off on your SOPs?

• What is the specialty of your team physician?

• Are you a Safe Sports School Award Winner?

• Are you a Gatorade Award Winner?

• Number of sports your school offers?

• How many athletes?

• Do you teach?

• What do you teach?

So you may be asking yourself: How can this benefit me? Well, do your teams ever travel out of state? Do your teams compete in state tournaments against teams that you are not familiar with? If you answered yes to either of these, the ATLAS project can be a method of communicating with the athletic trainer from a team in another state or a school on the other end of the state.

We will also be able to use the information we gather as a conduit for release of material that is of particular value to our setting. If you have read the news lately, there are many states that have had their athletic trainers’ credentials attacked. ATLAS would have been a great way to mobilize state members to contact their legislators and other stakeholders in a short period of time.

I hope that you can now see how and why Ronnie, Rob, and I got so busy planning the premise of this project that evening in New York City. We saw endless possibilities to benefit the secondary school setting and the athletic training profession. So next time you’re at a restaurant with a group of professional colleagues and the ideas start flying, grab a napkin and start writing. You never know what could happen.

Get on board, and help the NATA and KSI get all of the secondary schools across the country mapped. Your profession depends upon it. Go to http://ksi.uconn.edu/nata-atlas/and take the survey to get your school mapped.

Special thanks to Ronnie Harper for planting the seed and to Rob Huggins and Sarah Attanasio, ATC, Assistant Director of Research at KSI, for their continued help, support, and dedication to make this project a success.

Larry Cooper, MS, LAT, ATC, is Head Athletic Trainer at Penn-Trafford High School in Harrison City, Pa., where he also teaches health, physical education, and sports medicine classes. Since 2012, he has served as Chair of the NATA Secondary School Athletic Trainers’ Committee. Winner of a 2016 NATA Most Distinguished Athletic Trainer Award, 2015 T&C Most Valuable Athletic Trainer Award, and 2014 NATA Athletic Training Service Award, he was inducted into the Pennsylvania Athletic Trainers’ Society Hall of Fame in 2014. Cooper can be reached at: cooperl@penntrafford.org.

Growing up as an athlete in Louisiana, I was one of many teenagers who took to the football field for summer two-a-day practices. In the nearly tropical summer heat and humidity, we would practice and play in triple-digit temperatures – almost always in full padding. Between sessions, my teammates and I sometimes stood under cold showers for 15 minutes, wearing our full uniforms, just to try to cool ourselves down. It was in those temperatures that a player I knew collapsed and died on the field from exertional heatstroke, or EHS.

EHS can occur in otherwise healthy individuals and is different from classic heatstroke, which usually affects those who are very young, elderly or have pre-existing medical conditions. Athletes and soldiers whose uniforms require heavy gear are especially vulnerable.

Treatment for EHS has evolved very little over the centuries, essentially relying on external cooling methods. Water immersion, an earlier version of cold water immersion (today’s first line treatment for EHS), was described by the Greek physician Hippocrates in 400 B.C. But even as today’s young athletes and their parents are becoming better informed about the risks of concussion and dehydration out on the field, many believe that heat is merely uncomfortable and do not recognize the dire risks it can present.

Some of this risk could be reduced if high school athletic organizations followed the lead of professional and college teams in banning two-a-day summer practices, which unnecessarily subject young athletes to the risk of exertional heatstroke.

In April, the National Collegiate Athletic Association banned two-a-day summer practices for Division I college football players, on the basis of recommendations from medical professionals, coaches and administrators. The change is intended not only to control exertion on the field and promote recovery from it, but also to minimize injuries such as concussion and lower the risk of EHS.

The National Football League banned two-a-day practices six years ago, in 2011. But many high school football players still face the risks associated with two-a-day practices. Currently, guidelines vary across state lines. While states like Iowa have banned two-a-day practices, others like Georgia and Texas ban only back-to-back two-a-day sessions and other states still allow them.

I’ve served as a physician, researcher and consultant for more than 20 years in an effort to bring wide attention to the issues and threat of concussions in football. And now I have ample grounds to believe that EHS qualifies as an issue of similar importance. While many people think of EHS as a temperature issue, it’s truly a neurological and metabolic emergency that, if not treated, can result in irreversible damage to the brain, other vital organs, or even death. According to research published in the American Journal of Preventive Medicine, the number of injuries associated with exertional heat illness in the United States – most of which involved young people playing sports – increased by more than 130 percentbetween 1997 and 2006.

It is vital for EHS to be identified as early as possible, so that the person can be removed from the hot and humid environment and be treated. EHS occurs when the core body temperature rises to dangerous levels – 104 degrees Fahrenheit or greater. Such a high core body temperature, even for a short period of time, can cause permanent damage to the brain, liver, kidneys and other organs.

It’s particularly ominous when the central nervous system becomes involved; there is the potential for progression to coma and death. For those who survive, long-term and potentially irreversible neurological damage can occur, affecting cognition, movement, coordination and sensory systems. I’ve personally seen how such nervous system deficits can devastate patients, impairing everything from performing basic tasks to engaging in social interactions with friends. These effects often strike young, active patients who are in the prime of their lives. And because the effects of heat are cumulative, people who have had other heat stress experiences are more likely to experience heat illnesses – like EHS – again, and should take particular caution when exerting themselves in hot or humid conditions.

As a physician dedicated to the practice of sports medicine and as a former athlete, I’m committed to raising awareness of EHS and ensuring that parents, coaches, athletic trainers and others are prepared to recognize EHS and respond.

The Korey Stringer Institute, named for the Minnesota Vikings player who died of exertional heatstroke in 2001 at age 27, offers useful guidance on its website. In addition to a high core body temperature, the signs and symptoms of exertional heatstroke include fainting or dizziness, vomiting, confusion and disorientation and unusual behavior like aggression. Exertional heatstroke is a medical emergency, and fast treatment is critical.

If you see anyone exhibiting the signs and symptoms of EHS, call 911 immediately and initiate rapid cooling, ideally with an ice bath. It’s important to remember that seemingly healthy people can be at risk.

If organizations that represent high school athletes consider adopting the N.C.A.A.’s complete ban on two-a-day practices, they may help prevent fatalities like that of the player I knew years ago in Louisiana.

Julian Bailes is director of the department of neurosurgery and co-director of the NorthShore University HealthSystem Neurological Institute.

Associate Director of Communication and Assistant Director of Athlete Performance and Safety

Members of KSI had the opportunity to travel to Las Vegas, Nevada for the 40th annual National Strength and Conditioning Conference
where strength and conditioning coaches, personal trainers, sport scientists, sport nutritionists, and health enthusiasts gathered to present, network, and honor certain outstanding members.

We were fortunate to attend a lecture given by this year’s Sport Scientists of the Year, Shawn M, Arent, and Dave DiFabio from Polar, whom we had the opportunity to work with in the past. They discussed the use of wearable technology and how coaches and sport scientists should start thinking about applying the knowledge we gather from this data to practice.

Ryan Curtis, Yasuki Sekiguchi, and I presented some of the recent research findings from the KSI. I presented a poster titled, “Analysis of Women’s Cross Country Lab Tests Results and Training Over the Course of a Competitive Fall Season” on Thursday (7/13/17). I examined the change in lactate testing, VO2max and training of the UCONN Women’s Cross Country team during their fall season. The major finding of this study was the vOBLA (velocity at onset of blood lactate) was significantly higher during the middle of the season while VO2 max did not change throughout the season. During my presentation, I was very excited to reconnect with two of my former colleagues from Florida State University. Daniel Shaefer was the former director of strength and conditioning at FSU and is now working on is PhD at the University of Wisconsin-Madison. Jon Jost was the former FSU director of strength and conditioning and recently accepted a position with Gatorade. I am hopeful that we will get an opportunity to collaborate on future research. I also had the fortune to meet Kristen Holmes-Winn, from WHOOP, who funded the research Ryan and I presented at this conference.

Yasuki Sekiguchi presented a poster titled “Heartrate Variability between Starters and Nonstarters throughout a Collegiate Soccer Season.” During this study, HRV and training load metrics were monitored over the course of D1
college soccer season. The relationship between these variables were examined for all players, starters, and nonstarters. The major finding of this research was that acute:chronic training load ratio might be used to explain the changes in HRV over the course of a Division 1 male soccer team

Ryan Curtis did an oral presentation on Saturday (7/15/17) titled “Relationship between Sleep, Training Load and Fitness in Collegiate Soccer.” Overall this study illustrated that sleep quality may be more sensitive to increased training load than sleep quantity. Collegiate athletes with increased training loads have increased light sleep but not REM sleep or overall sleep duration.

Outside of the conference, we had a fantastic time exploring the Las Vegas strip and the beautiful hotel hosting us and the conference, Paris Las Vegas. I am extremely thankful to the NSCA and KSI for the opportunity to collaborate and learn from others in the field while making memories that will last a lifetime. I look forward to attending this event next year and present the results from our upcoming projects.

Every year, we are plagued with the news of young athletes dying or suffering catastrophic injuries while playing the sports that they love. While being multi-causal, the most likely culprits are sudden cardiac arrest, head injuries and exertional heat stroke. While death during sport (or physical activity) cannot be 100% prevented, there are some key strategies that can be taken to ensure that these risks are mitigated. Factors such as appropriate healthcare coverage during training and competition, venue-specific emergency action plans, access to an automated external defibrillator and heat acclimatization for preseason practices are effective means to mitigate risk. Below is an explanation of these fundamental policies and procedures that should be implemented at all levels of sport to ensure the health and safety of our athletes on the playing field.

1. Access to appropriate healthcare. Having access to appropriate healthcare (i.e. athletic trainers, sports medicine physician or other healthcare providers trained in sports medicine), is a vital aspect for any athletics program. These individuals are trained in the recognition, evaluation, treatment and return to activity of sport related emergencies. Having these individuals onsite for all sanctioned practices and competitions where the risk of sudden death is high ensures that, in the event of an emergency, prompt care can be given, which helps optimize the outcomes for the athlete.

2. Emergency Preparedness. In addition to having access to appropriate healthcare for all sanctioned training and competition, having a regularly rehearsed, venue-specific emergency action plan (EAP) allows all members associated with any athletics program to have a plan in place in the event of an emergency from occurring. Having a well-established EAP dictates the roles and responsibilities of each member of the athletics team and minimizes the time to point of care services during emergency situations.

3. Immediate Access to an Automated External Defibrillator (AED). Sudden cardiac arrest is the number one medical condition resulting in death during participation in sport or physical activity. The utilization of an AED during a cardiac event is an effective method to ensure survival; however, the chances of survival decrease roughly 10% for every minute defibrillation is delayed. With sudden cardiac arrest being the number 1 reason causing athletes to die during sport, having this life-saving device within 1-3 minutes of any venue hosting training or competition minimizes the time from defibrillation. Evidence shows that when an AED is utilized within one-minute of sudden cardiac arrest, survival is as high as 90%, thus justifying the need to have an adequate number of AEDs to service an athletics program at any and all institutions.

4. Heat Acclimatization. Exercise in hot environmental conditions not only adds additional stress on the body (both cardiovascular thermoregulatory strain), but exercise in the head can greatly increase the risk of exertional heat stroke if an individual is not accustomed to exercising in such conditions. Heat acclimatization, the physiological adaptations that occur following repeated bouts of exercise improves ones ability to exercise in the heat. Adaptations such as increased sweat rate, decrease exercising body temperature and heart rate and earlier onset of sweating allow for a greater ability to mitigate the risk of exertional heat stroke. The method of becoming heat acclimatized is a gradual progression of exercise duration, intensity and the wearing of protective equipment (i.e. football equipment, field hockey goalie equipment, etc.). This method has proved effective at both the NCAA and high school levels especially for football with only 2 football players dying from exertional heat stroke during August preseason practices since the 2003 implementation of the policy (saving 25-30 lives in the process). At the high school level, there have been zero exertional heat stroke deaths since any state athletics association has mandated this policy.

“It’s like a regular tired feeling,” according to Jerraud Powers, who played defensive back for eight NFL seasons with it.

If the player tries to power through, as football players so often do, the symptoms rapidly get worse.

“There’s constant cramping,” said former Ravens receiver Devard Darling, who lost his twin brother to the condition. “Once it starts, it usually doesn’t stop.”

“For someone who doesn’t have it, if they are running 20 ‘110s’ [sprints], they are dying on the 18th one.” Powers continued.

Then he corrected himself. “Not dying, you know. They are just physically exhausted.”

For those with sickle cell trait, which has killed 11 college football players since 2000, according to the Lincoln Journal Star, the exhaustion comes sooner. “If you have a flare-up, you might feel it on the eighth or ninth sprint,” Powers explained.

The athlete’s body demands a break. But his mind—and his coach—may have other plans: No football player wants to appear weak or out of shape. So he keeps going.

If he doesn’t stop when the flare-up occurs, his own blood cells rapidly start trying to kill him. They form into crescent shapes and clog the blood supply to his muscles. The muscles die due to lack of oxygen. They dump their contaminants into the bloodstream, which, according to Dr. Kimberly Harmon of the University of Washington, interrupts the electrical system in the heart and causes cardiac arrest.

“There’s a point of no return,” according to Dr. Harmon. “And where that is differs for everybody.”

Pushed past this point of no return, the athlete literally, suddenly works himself to death.

The sickle cell trait can kill an otherwise-healthy, well-conditioned person in minutes. It affects 1 million to 3 million Americans (and roughly 1 in 12 African-Americans) overall, as well as countless pro, college and prep athletes.

Powers (No. 8) knew he had SCT while at Auburn but didn’t come to understand its affect on his ability to train until he was in the NFL.Wesley Hitt/Getty Images

Most know they have it. But SCT is still a cause of confusion and controversy. And many young athletes still don’t know all the risks.

Deceptively dangerous

Jerraud Powers thought he was just out of shape.

“I’d be tired, and trying to figure it out,” he said. “I’m doing the same workouts with everybody else, but I’m the only one that’s dying. I would think, ‘Oh my God, I’m not gonna make it.’

“I just thought, ‘maybe I just need to stay and do some extra stuff to get in better shape.'”

Powers knew he possessed the sickle cell trait. He just did not know it could affect him. The symptoms and dangers of sickle cell disease are well-known. But the trait is just a genetic marker, not the disease itself, and until recently doctors believed it was nearly harmless. Powers was told from an early age that the trait would only impact his life if he had a child with a woman who also possessed it: That baby would be at a very high risk for the much more serious disease.

So Powers, then in high school, worked out in the sweltering Alabama heat with no safety precautions. When he got to Auburn, he talked to strength-and-conditioning coaches about his workout woes. “We talked about everything but the trait,” he said.

It wasn’t until Powers began playing for the Arizona Cardinals four years ago that he was informed by an independent doctor about the symptoms of sickle cell trait and the perils he unknowingly faced as a younger athlete.

The risk of sudden death among college football players possessing SCT was 37 times higher than the risk among the players without the trait, according to research conducted by Harmon at the University of Washington looking at college athletes from 2004 to 2008. The mortality rate among college football players with SCT was one in 827 in the mid-2000s, shockingly high for a population of young, outstandingly fit individuals.

The risk factor is compounded when the athlete feels pressure to push beyond his ordinary limits.

“The vast majority of people who have sickle cell trait are asymptomatic,” according to Harmon, the University of Washington football team’s physician and a top sports medicine researcher.

“The only time it ever becomes an issue is with really hardcore physical activity. The two times people have problems with it are when they can’t stop or feel like they can’t stop.”

In other words, Powers’ belief that he needed to exercise even harder could have killed him.

Powers left Auburn after the 2008 season, before the NCAA initiated mandatory SCT testing and other precautions for all athletes in 2010. He was quick to assert that trainers didn’t know as much about the trait as they do now.

But Dr. Douglas Casa, sports medicine researcher at the Korey Stringer Institute, points out that many programs were independently testing long before the 2010 mandate, and that a position statement urging better precautions for athletes with SCT (co-authored by Casa, Harmon and others) was published in 2007. “It was certainly on the radar for a long time before the rule change in 2010,” he explained.

Dr. Douglas Casa, here testifying in the wrongful death suit of Central Florida’s Ereck Plancher, believes that college athletic programs should have known about the dangers of sickle cell trait before the NCAA-mandated testing for the condition in 2010.Gary W. Green/Associated Press/Associated Press

Still, the range of care and quality of SCT education was wide a decade ago. “No one was educated about the risks of sickle cell trait,” Casa explained. “That’s something you educated yourself about as a medical professional.”

Powers relied on common sense to keep from overexerting himself in high school and college, even when his peers were outperforming him in workouts. “I was always a guy who knew my limits. If I felt like I was getting tired, I would take myself out.”

But college football is a culture of pushing past limits, whether to win a championship, preserve a scholarship or please a powerful coach. And too many athletes have pushed themselves past SCT’s point of no return in the last decade.

The workhorse

Like most identical twins, Devaughn and Devard Darling were nearly inseparable. But their paths diverged on the gridiron: Devard became a wide receiver in high school, while Devaughn was a two-way player heading toward a college career at linebacker.

Devaughn and Devard Darling on the Florida State sideline, circa 2000.Photo courtesy of the As One Foundation

“In our last year of high school, Devaughn was the workhorse,” his brother recalls. “He played offense and defense. And he would always cramp in the fourth quarter.”

There’s nothing unusual about a two-way player cramping up in the Texas heat late in the game. But the Darlings possessed the sickle cell trait. The Bahama-born twins were never tested for the condition, so no one knew they had it. And because this was the late 1990s, few understood the associated risks.

“We just thought he was getting overworked,” Devard said. “Obviously, he was. But those were the telltale signs. Looking back, we should have paid more attention to that.”

The Darling twins found out they possessed SCT during their freshman physicals at Florida State. No accommodations were made for them. At dawn on a February morning in 2001, the twins lined up for then-head coach Bobby Bowden’s legendary “mat drill,” an hour-plus of high-speed tumbling, running, rolling and crawling, a regimen that would give a Marine drill sergeant pause.

“There was an unwritten rule that we couldn’t get water,” Devard remembers. “And the No. 1 rule was: You can’t quit. They used to say, ‘before you die, you will pass out. And if you pass out, the trainers will take care of you.’

“That was our mentality. That was drilled into our heads.”

Devaughn, who had passed out during the previous Thursday’s workouts, fell to his knee after an exhausting series of tumbles on the morning of February 26. He complained of chest pains and blurred vision, according to a report by Michael Krause for SB Nation. Coaches ordered him to finish the drill.

“It got to the point where they were just sending Devaughn back by himself over and over again,” Devard said.

He finished the drill and collapsed. He was pronounced dead less than two hours later. Bowden called Devaughn “the first player I’ve ever coached in 47 years who actually worked himself to death.”

It was a tragic death, as well as an almost certainly preventable one. The Darling family sued for damages. The university agreed to a $2 million settlement in 2004, though the bulk of the money was held up by legal red tape for more than a decade.

The Darling family was awarded $2 million from Florida State after Devaughn Darling died after an exhaustive series of workouts at the school in February 2001.Mark Wallheiser/Associated Press/Associated Press/Associated Press

It was not the first SCT-related football death, and it would be far from the last.

Gone forever

Deaths from complications associated with sickle cell trait have been common enough over the last 20 years to fall into a predictable pattern.

Ereck Plancher of the University of Central Florida died in March 2008 after an extended series of conditioning drills in which, according to testimony by one of Plancher’s teammates, players were denied water and training staff was excluded from the sessions. The teammate also testified that then-Central Florida head coach George O’Leary yelled obscenities at Plancher, whose SCT condition was documented, as he struggled to his feet during an intense workout in a field house nicknamed “The Oven.” A jury awarded the Plancher family $10 million in a wrongful death suit against the university; later, that figure was capped at $200,000, due to Florida’s complicated immunity laws.

Cal’s Ted Agu died in February 2014 after a drill that required him to sprint up and down a hill while connected to his teammates by loops of rope. Agu, a linebacker entering his senior season, began stumbling and struggling midway through the workout and collapsed halfway up the hill, according to his teammates, far from trainers and emergency equipment.

The Agu family was awarded $4.75 million in wrongful death damages. The University of California acknowledged liability in the case.

Dr. Casa served as an expert witness in the Agu and Plancher cases, among others, and found many common factors among SCT-related deaths.

“There’s lack of proper preparation,” he explained. “The athletic programs had the knowledge of the sickle cell trait, but they didn’t implement best practices to prevent the condition. Once it happened, they didn’t take care of the person properly.”

Ereck Plancher’s parents, Gisele and Enock, leave the courtroom during the wrongful death trial of their son, who died in 2008 while a member of the University of Central Florida football team.Gary W. Green/Associated Press

Casa’s research into individual cases reveals bumbling that would almost be comical if it weren’t so tragic. Plancher was tested for SCT twice by Central Florida. The university lost track of the first result, according to Casa. Even after Plancher had tested positive for SCT in two separate screenings, the program “didn’t appear to employ precautions that had been recommended by a national athletic trainers’ organization nine months before Plancher died,” wrote ESPN’s Mark Fainaru-Wada regarding an investigation of the case by the network’s Outside the Lines program.

Casa himself jogged up the hill where Agu died. It’s L-shape and steep slope made it impossible for trainers stationed at the bottom of the hill to supervise athletes near the top. An automated external defibrillator and other medical equipment were stored far from the field; Casa said that Cal’s trainer neglected to bring the potentially life-saving equipment (smaller than a laptop bag) with him for the remote training session.

“We can look at every case and find flaws,” Casa said. “But the bottom line is that the kid ends up being gone forever…just because other people couldn’t implement simple policies or didn’t have support from the athletic department.”

The culture of college football is also a factor: Bowden-like tough-guy coaches, the never-quit attitude, the fear athletes face when confronting a coach or even standing up for a struggling teammate (starting jobs and scholarships can hinge on absolute obedience), a disconnect between coaches, trainers and the medical staff about where rigorous conditioning ends and reckless endangerment begins.

“The football strength-and-conditioning sessions at the college level, unfortunately, have been so unregulated for a long time that it was like the Wild West,” Casa said. “They could do anything they want.”

The NCAA has made efforts to address the issues in recent years, but those efforts come with their own set of controversies.

The NFL, meanwhile, has gone a decade without a serious SCT-related incident.

Nothing out of the ordinary

When most football fans hear the words “sickle cell trait,” they think of former Steelers safety Ryan Clark, who nearly died from a flare-up of the condition after a game against the Broncos in 2007.

Steelers safety Ryan Clark had his spleen and gallbladder removed when his SCT flared up after a game played in the Denver altitude.Gene J. Puskar/Associated Press/Associated Press

Doctors knew Clark possessed SCT, but they did not associate his intense postgame pain with the condition despite the obvious exertion-at-altitude red flags, according to an SB Nation interview by Sarah Kogod. Clark suffered through high fevers and constant pain for weeks before doctors realized that sickled blood cells caused tissue death in his spleen. He eventually had both his spleen and gallbladder removed. And though Clark ultimately returned to the NFL, he never again played a game in Denver.

Clark’s story is well-known and harrowing. It is also atypical of the NFL experience for an SCT carrier, especially now that the risks associated with the trait are better understood.

Once Powers understood the risks of playing through SCT, he reached out to Clark (as well as doctors and trainers) for advice before facing the Broncos in Denver. He decided to play what turned out to be a grueling game against Peyton Manning‘s high-powered offense in 2014.

“Even though I was fatigued like everybody else, it wasn’t anything out of the ordinary,” Powers said of his appearances at Mile High Stadium. “I knew if I got to a certain point where I needed a break, I wasn’t going to hesitate to take myself out of the game.”

Other SCT carriers in the NFL have made similar decisions. Geno Atkins played in Denver both in 2011 and 2015. Atlanta Falcons running back Tevin Coleman chose to play there last year.

“I remember just running to the bench to get a tank of oxygen because I was just dead tired,” he said in the feature. “That was the first time I felt fatigued, tired and couldn’t really catch my breath as [I could] if we were in Cincinnati. You are still able to as long as you are aware of it and take the proper steps.”

Not all NFL players with SCT have enjoyed near-symptom-free careers. Cardinals receiver John Brown slipped through the cracks of the NCAA’s screening policy. He attended Pittsburg State, which as a Division II program was not required to screen incoming athletes until 2012. Brown was not diagnosed with SCT until last year when doctors investigated the chronic leg pains that slowed him in the first half of the season.

Football games themselves are not high-risk events for SCT episodes: frequent substitutions and breaks between plays give players plenty of ways to regulate their exertion levels. Once in the NFL, players are protected by collective bargaining (conditioning activities are tightly structured and regulated) and a (generally) enlightened attitude about conditioning from exercises like the mat drill.

As a result, NFL players have a matter-of-fact attitude toward a manageable health condition. “Knowing what I know now,” Powers said, “I can tell whether it’s a flare-up or if it’s because I ate some pizza last night that I shouldn’t have before I ran.”

At the college level, however, SCT remains a controversial matter, starting with the NCAA’s screening policy.

A test fraught with peril?

The gene that causes sickle cell trait, a mutant strain of one of the genes that tell the body how to form hemoglobin (the oxygen-carrying molecules in our bloodstream), carries a surprising hidden evolutionary advantage. When a person with the mutation is stricken with malaria, their red blood cells are more likely to be quickly processed and eliminated by the spleen, taking the sometimes-deadly infection with them.

That means the sickle cell trait was naturally selected among populations in regions where malaria outbreaks were common throughout human history, particularly Africa. Which is why an estimated eight to 10 percent of African-Americans carry SCT, according to the American Society of Hematology. The condition is relatively rare among the rest of the American population.

That makes an otherwise simple health screening a matter fraught with racial overtones and perils.

Cardinals receiver John Brown did not find out until last year that he carried the sickle cell trait, which doctors identified as the cause for leg pains he suffered early last season.Hannah Foslien/Getty Images

After the NCAA began screening all athletes for SCT in 2010, several medical and healthcare advocacy groups denounced the policy. An article titled “Screening Student Athletes for Sickle Cell Trait—A Social and Clinical Experiment” appeared in the New England Journal of Medicine. That article outlined a long list of questions and concerns, ranging from medical privacy concerns to issues of stigmatization, self-image and future employability. Even now there are questions as to whether the trait causes exertion-based deaths at all or is simply a genetic marker for another problem.

Seven years later, those concerns remain valid, according to Dr. Biree Andemariam of the Sickle Cell Disease Association of America, one of the institutions opposed to the NCAA’s screening policy.

Athletes who test positive for SCT “could get passed over for scholarships,” Dr. Andemariam said. “They could get passed over for playing time. They could be seen as a liability.”

And the athletes passed over for scholarships or starting opportunities would be overwhelmingly, though not exclusively, African-American.

“Yes, it would proportionally affect those of African heritage, no doubt about it,” Dr. Andemariam agreed. “But we’re concerned about everyone who could potentially be stigmatized at a pivotal point in their careers.”

That may seem like a misplaced fear at first; after all, several prominent NFL players possess SCT, offering both evidence that the NCAA is not denying opportunities to carriers of the trait and examples to programs of how successful SCT-carrying athletes can be.

“It’s not going to deter a coach from offering a kid a scholarship,” Devard Darling said. “You know how coaches are. I haven’t heard of anyone getting discriminated against or anything.”

Darling, ironically, is one of the high-profile examples of a player whose college football career was disrupted by SCT. After Devaughn died, Florida State refused to let him back on the field.

“I learned the business of college football really quick when that happened. They saw me as a liability. I had a Florida State doctor look me in the eye and tell me I was never going to play football again after asking me three questions.”

Yet Darling quickly got another opportunity at Washington State. “Someone still picked me back up,” he said. “If you can play, you can play.”

Devard Darling was forced to transfer to Washington State when Florida State officials refuse to let him play again in the wake of his brother’s death due to sickle cell trait.Otto Greule Jr/Getty Images

But not everyone can play college football at Devard Darling’s level. What happens to a fringe player in line for one of a small program’s final scholarships, or a freshman who must be held out of his coach’s favorite drag-ropes-up-hill conditioning drill?

“We know about the ones who have successfully made it,” Dr. Andemariam said. “We don’t know about the ones who didn’t. We don’t have that data.”

Dr. Brian Hainline, chief medical officer of the NCAA, points out that the screening-and-education program has not just gotten results—just one SCT-related death since 2010, large numbers of SCT-carrying athletes competing across collegiate sports and levels—but changed attitudes.

“I think we’ve eliminated the stigma at the NCAA level,” Dr. Hainline said. “It’s just considered routine. You may have a sickle cell trait-carrying athlete, and that athlete is ultimately going to compete at the same level as everyone else. You just have to put safeguards in place.”

Organizations like the SCDAA believe the safeguards and education would work just fine without the screening. The U.S. Army does not screen recruits. It has used the “universal precautions” approach to prevent exertion-related deaths since 1996, a protocol endorsed by the SCDAA. Even in boot camp, there’s no good reason to push any individual to the point where they collapse from exhaustion.

Yet even in a well-regulated, well-designed conditioning drill, emergencies happen. For team physicians, knowing that a player has SCT can make the difference when a medical crisis occurs.

“For my athletes, I want to know if somebody has asthma, if someone has diabetes, so I can watch them closely and take special precautions,” Dr. Harmon said. “If somebody’s struggling, your differential diagnosis changes how quickly you need to act and what you need to do if you know they have an underlying medical condition.”

Falcons running back Tevin Coleman and a handful of NFL players with SCT have found playing in Denver can exacerbate the potential effects of physical exertion.Dustin Bradford/Getty Images

While all infants in the United States are screened at birth for the disease, parents often forget about a condition unlikely to affect their child for many years, and medical record keeping in the United States can be haphazard. Many athletes reach college age not knowing their status, so the choice becomes screening (and potentially discriminating against) an at-risk population or placing members of that population at an increased health risk.

“We don’t screen men for breast cancer,” Dr. Harmon said. “Nobody seems to get upset about that. But when you overlay this filter of race, it becomes political.”

“If I had a black athlete in high school in any sport where they would be training intensely, I’d test them. To me, that’s just pragmatic.”

Prevention versus exploitation

More than anything else, Devard Darling misses the quiet times with his late twin brother.

“The times it was just us two, together in our room, chillin’. The things that only I shared with him and he shared with me. I look back and I laugh at times, but no one else can relate because it was just me and Devaughn there. Those special times we had as twins, always having someone there for you, that bond that we had.”

Devaughn Darling was buried in a Florida State Seminoles uniform. The university awards a scholarship in Devaughn’s name. But Devard and his family are not involved in the scholarship program in any way. “They have been so standoffish to me and my family,” he said.

The Darlings were awarded $2 million in damages from Florida State in 2004. Due to the vagaries of Florida state law, the family just earned legal rights to the bulk of that money only two months ago.

What’s most frustrating about SCT-related deaths is how preventable they are. Experts constantly compare SCT to asthma or bee-sting allergies: Know your condition, inform your trainer, carry an EpiPen or inhaler (or hydrate and know the warning signs for overexertion) and the risks can be trivialized.

“It doesn’t take a high IQ to manage this,” Casa said.

Devard Darling now speaks to young athletes and students about the importance of finding out if they carry the sickle cell trait and how to navigate the condition.Photo courtesy of the As One Foundation

But unlike asthma or other conditions, SCT touches on many of our national anxieties and political hot buttons, from racial inequality to inequities in health care and education to the outdated macho-guy attitudes about conditioning that some coaches still cling to.

The trait-carrying college football player navigates a minefield between a test that could jeopardize his career and workouts that could jeopardize his life. The NCAA sets standards, but experts like Casa worry about whether all member programs will rise to them once the field house doors close.

“We’re willing to exploit their ability to perform at their best,” he said. “But we’re not willing to back it up with the proper health and safety standards.”

At lower levels, high school and youth athletes who immigrated to the United States or had a non-traditional upbringing (adoption, foster care, custody issues, blended families, etc.) may not know their status. And youth coaches and high school trainers may lack the training or resources to deal with an SCT episode.

Indeed, there have been many changes for the better in recent years on the SCT front. But there are too many ways a young athlete can be placed at unnecessary risk. And all the positives steps arrived too late for the football players who died as the result of misinformation, indecision or the outright stubbornness of a coach or program.

“It’s unfortunate that Devaughn had to die for so many things to change,” Darling said.

Athletic trainers from around the country gathered in Houston, Texas for the 2017 Annual NATA Clinical Symposia & AT Expo. The four day Clinical Symposia provided athletic trainers with the ability to explore new areas and benefit from the latest research. KSI was well represented by fifteen presenters who continued the mission of educating athletic trainers about our latest research. The warm weather of Texas was a constant reminder of the significance of heat in our southern states, but the strong interest showed by attendees from across the country demonstrated that athletic trainers are gaining an understanding that exertional heat illnesses are an issue of national concern. The selection of so many KSI members provided a unique opportunity for KSI to further its educational mission to maximize performance, optimize safety and prevent sudden death in sport.

Presentations kicked off early Tuesday morning when Andres Almeraya presented in the Master’s Oral Student Finalist session. His research about “Implementation of Automated Defibrillator Policies in Secondary School Athletics” demonstrated the strong need for additional state legislation to mandate that all secondary schools follow best practices. Andres entered the day as a finalist and was selected overall the best oral presentation in this section. Congratulations and well done, Andres! Dr. William Adams presented his work on the “Implementation of Heat Acclimatization Policies in Secondary School Athletics” during the Treat the Heat Session.

This year four KSI staff members: Luke Belval, Alexandra Finn, Rachel Katch and Brad Endres were selected to present a Free Communication Poster Presentation on Tuesday morning. Luke Belval presented on “Sex-based Comparison of Exertional Heat Stroke Incidence in a Warm-Weather Road Race.” Alexandra Finn presented on the “Implementation of Wet Bulb Globe Temperature Policies in Secondary School Athletics.” This research revealed that currently there are only three states that meet all the best practice recommendations in this area. Rachel Katch presented data titled “Cold Water Immersion in the Treatment of Exertional Heat Stroke Remains the Gold Standard at the Falmouth Road Race,” which demonstrated the significance of a road race having immediate cold water immersion available to treat exertional heat stroke. Finally, Brad Endres presented on the “Epidemiology of Sudden Cardiac Death in American Youth Sports.” Congratulations to both Alexandra Finn and Brad Endres who were selected as Master’s Poster Presentation Finalists. Brad’s poster proved to be the judges’ favorite taking home top honors for KSI in this category. Well done Brad and his research team!

To finish the day, Dr. Robert Huggins provided an update on “An Overview of Secondary Schools ATLAS Project: Where Are We Now?” demonstrating the progress in mapping secondary schools across the nation.

The second day started off strong with three KSI members presenting. First, Sarah Attanasio provided insightful information about the ATLAS project. In a well-attended session, Dr. Douglas Casa discussed “Catastrophic Heat and Exertional-Related Condition Among Athletes.” Lastly, Samantha Scarneo presented data about “Implementation of Emergency Action Plan Policies in Secondary School Athletics.” Her study focused on the importance of every high school having an athletic trainer prepare an emergency care plan.

On the final day of presentations KSI members Kelsey Rynkiewicz, Dr. Robert Huggins, Dr. Yuri Hosokawa, Dr. William Adams and Alicia Pike all had an opportunity to present their data. Kelsey Rynkiewicz presented data on the “Implementation of Concussion Policies in Secondary School Athletics.” Dr. Robert Huggins presented on three different topics on Thursday. The first presentation looked at the “Presence of Athletic Trainers, Emergency Action Plans, and Emergency Training at the Time of Sudden Death in Secondary Athletics.” His second presentation provided data to support why all athletic trainers should be staffed and the importance of an athletic trainer in the ability to reduce risk and save lives. His last presentation was titled “State High School Athletic Policy Change Successes and Barriers: Results from Collaborative Solutions for Safety in Sports Meeting.” Dr. Yuri Hosokawa presented information on “Optimizing the Direction of Care: A Secondary Insurance Claim Analysis.” Dr. William Adams presented information on the “Current Status of Evidence-Based Best Practice Recommendations in Secondary School Athletics.” Lastly, Alicia Pike looked at “Examining Sport Safety Policies in Secondary Schools: An Analysis of States’ Progress Toward and Barriers to Policy Implementation.”

It was a privilege for so many KSI members to have the opportunity to provide much needed information about subject matters such as the prevention and care of exertional heat illnesses to athletic trainers who are heading to summer sport training camps or planning for preseason training for fall sports. When not presenting, KSI staff members took advantage of the tremendous opportunity to learn from colleagues from other institutions. The annual conference, which will be moving to New Orleans, LA next year, is well worth the investment to attend!